Case Study-Cerebrovascular Accident (CVA)
It is early morning and N.T., a 79 year old woman is getting out of bed. She has a mild headache over the right temple, is fatigued and feels slightly weak. She calls for her husband to let him know she will be going back to bed for a while. When her husband comes in to check her he finds that she is having trouble saying words and has a slight left sided facial droop. When he helps her up from the bedside, he notices weakness in her left hand and convinces her to go to the local ED (Emergency Department). Her first CT (Computed tomography) scan was negative for CVA (cerebrovascular accident), however the second CT scan ( 18 hours later) reveals a small CVA in the right hemisphere. She is still experiencing expressive aphasia, left facial droop, left sided hemiparesis and what is presumed to be symptoms of mild dysphagia. Her PMH(past medical history) includes paroxysmal A-fibrillation, HTN (hypertension), hyperlipidemia, and a remote history of DVT (deep vein thrombosis). A recent cardiac stress test was normal and her blood pressure has been well controlled. She admits to being under recent stress with the death of her husband’s adult son. She is hospitalized for 4 days and discharged with orders for outpatient rehabilitation for speech and physicial therapy. Medications prior to the CVA were flecanide, HRT(hormone replacement therapy), amlopidipine(Norvasc) aspirin, simvastiatin(Zocor), and trandoloapril(Mavik). She is discharged on flecanide, amlodipine, clopidogrel(Plavix), aspirin, simvastatin and trandolopril.
1. What other information would be necessary for evaluating the cause for the CVA?
2. If her deficits are temporary, how long might it take before they are completely reversed?
3. Why was N.T. placed on clopidogrel post CVA
4. Why was the initial CT Scan negative for stroke
5. N.T. is not on HRT ( hormone replacement therapy) post CVA. Why should this medication be discontinued.
6. Is there any benefits from continuing simvastin after her CVA?
7. Is there treatment that can be initiated in the ED to stop a CVA from progressing?
8. Your co-worker states, “I always heard that paroxysmal atrial fibrillation is a precursor to stroke. Is this statement true or false?
9. Which of the following is not a symptom of CVA
10. As you walk to the nurses station, the charge nurse is talking to N.T doctor. She ordered a modified barium swallow study and referral to speech –language pathologist. OT(occupational therapist and RD(registered dietician). Give the rationale for theses orders
11. What lab test may be abnormal during CVA